The term carcinoma is a medical term: more precisely, it comes from pathology and describes a certain type of malignant tumor. In this respect, it is also beneficial for affected patients to understand the word and to have an overview of the associated problems and treatment approaches. Of course, every tumor is different; a lung cancer has a completely different therapy and prognosis than a testicular cancer. However, since both are carcinomas, there are principle similarities. Therefore, the following is a general overview.
What is a carcinoma?
Graphic illustration and infogram of a typical cancer cell. A carcinoma is a malignant tumor (cancer) that originates from the covering tissue (epithelium) of the skin or mucous membranes. Since most cancers originate from such epithelia, about 80 percent of them are classified as carcinomas, including bronchial carcinoma (lung cancer), mammary carcinoma (breast cancer) and colon carcinoma (colorectal cancer) as three of the most common cancer entities overall. Depending on the type of underlying epithelium, further classification can be made into squamous cell carcinoma (from squamous epithelium), adenocarcinoma (from glandular tissue), and other less common categories.
Causes
Causes of carcinomas are confusing, far from fully understood, and also cannot be generalized to all cancers. Basically, cell divisions occur constantly in many cells and tissues of the body. In particular, the surfaces (epithelia) are exposed to strong stresses both externally (skin) and internally (intestine, lungs) and therefore need to be renewed regularly. Epithelia are thus by nature particularly division-active tissues – which is why cancer development occurs so frequently there. During cell division and DNA duplication, errors regularly occur in which the control over cell division is lost and a single cell is thus put into a state of wanting to continue to divide uncontrollably. Such small cancer cells develop in each of us many times a day – in this respect, the development of cancer is also a question of chance. However, a healthy immune system is not only capable of defending itself against viruses and bacteria, but also of immediately destroying cancer cells that have developed. Immunodeficiency can therefore favor the non-detection and thus the further growth of a tunmor cell. Another major risk factor is damage to the tissue by external agents. The classic example is damage to the epithelium of the bronchial tubes by nicotine and other components of cigarette smoke – this weakens the defense layer of the bronchial mucosa and directly damages the DNA of individual mucosal cells. The epithelium transforms itself through continuous exposure to smoke to become more resistant (metaplasia) – but in the process it also loses its ancestral structure and the body loses control over epithelial growth; bronchial carcinoma can develop. In the case of colon cancer, lack of dietary fiber (i.e., culturally based malnutrition) has been identified as a major risk factor, as it leads to chronic constipation, which allows other dietary toxins to act on the intestinal mucosa for a longer period of time. Genetic factors are also important here, as in many other cancers. Meanwhile, carcinomas of the upper gastrointestinal tract (e.g., gastric carcinoma) or of the urinary tract (such as renal carcinoma or bladder carcinoma) are frequently associated with nitrosamines, cervical cancer with papilloma viruses, and white skin cancer with chronic exposure to UV light. Thus, for the many different carcinomas, there are many different risk factors that have more or less direct and major influence on tumor development.
Symptoms, complaints and signs
The symptomatology of such a carcinoma, and thus the time of its detection, naturally depends very much on the location of the tumor. A skin cancer tends to be seen and treated early, whereas a lung tumor may grow unmolested for years and may have metastasized throughout the body by the time it is diagnosed. Bleeding is a common initial direct symptom of internal tumors (blood in the stool, blood in the urine, bloody cough) and therefore must be investigated. Functional impairment can affect the hollow organs and lead to constipation (colon carcinoma), cough (bronchial carcinoma) or biliary colic and jaundice (bile duct carcinoma).Other tumors, such as gastric carcinoma, are not detected at all for a long time because the hollow organ is simply large enough to bypass the tumor. Bone metastases in particular can also cause severe pain and thus lead to the discovery of the initial tumor in the first place (e.g. in the case of spinal metastases of prostate carcinoma). Analogously, brain metastases can become noticeable through a change in the patient’s nature or a loss of sensory organs and can be the first symptom of a malignant carcinoma in a completely different location. Otherwise, there is the term “B-symptomatics” in medicine: This refers to all those unspecific symptoms that do not point to a specific tumor, but overall very often accompany a malignant cancer and should therefore be observed: These include weight loss, loss of appetite, weakness, fatigue, increased temperatures, night sweats and similar complaints. These symptoms arise because the rapidly growing tumor devours a huge amount of energy for its growth, which the rest of the body then lacks. Anemia as a result of gradual blood loss (tumor bleeding) and accompanying inflammatory processes may also contribute to the symptomatology.
Diagnosis and course of the disease
Diagnosis includes a thorough history with specific questioning about symptoms, risk factors, and concomitant phenomena. A family history is also important, since some tumors are hereditarily clustered. The physical examination can sometimes confirm the suspicion of a tumor, for example if a colon cancer can already be palpated with the finger in the buttocks. This is followed by imaging examinations such as ultrasound, X-rays, CT and MRI, which are used both to precisely visualize the cancerous tumor and to search for metastases. In order to plan treatment, it is important to obtain as comprehensive an overview as possible of the state of the disease, as this provides the basis for a variety of different and well-researched treatment strategies, and metastases, for example, can fundamentally change the treatment protocol. In oncology (cancer medicine), this is referred to as “staging”, i.e. the classification of the tumor into different categories according to its stage. A popular classification here is the TNM classification according to tumor size, nodal (lymph node) status and metastases. Almost always, an attempt is made to obtain a tissue sample (biopsy). Only on the basis of this can the tissue type of the tumor be proven beyond doubt and certainty be gained in the selection of the correct therapeutic approach. The pathologist refers to this as “grading” (i.e., one can prove the degree of tumor development).
Complications
In any case, a carcinoma represents a very dangerous health condition for the patient. It is not uncommon for it to lead to the death of the affected person, either by itself or because of its consequences. For this reason, early detection and treatment is extremely important so that potential complications can be avoided. The symptoms and complications of carcinoma usually depend to a large extent on the region affected. Furthermore, the cancer usually spreads to other regions of the body and can also affect and damage healthy tissue. Especially in the brain, this leads to changes in personality or to paralysis and other motor deficits. The affected person suffers from severe weight loss and weakness. The resilience of the affected person also decreases and there is a permanent fatigue, which cannot be compensated with the help of sleep. Treatment of the cancer is not possible in every case. In many cases, this also reduces life expectancy. Chemotherapy can cause many severe side effects, such as hair loss, and thus continue to reduce quality of life of the affected person.
When should you go to the doctor?
In the case of unusual and incomprehensible swellings on the organism, a clarification of the complaints by a doctor should be made in principle. If there is a feeling of tightness in the body, bulging or the development of ulcers, medical examinations are necessary. Since 80% of carcinomas are responsible for the development of a malignant tumor, a doctor should be consulted already at the first discrepancies. If there are respiratory impairments, abnormalities in digestion, headaches or various functional disorders, a visit to the doctor is advisable.If the symptoms have a persistent or increasing character over several weeks or months, the observations should be discussed with a physician immediately. If existing complaints gradually spread, there is also an urgent need for action. To determine the cause, a visit to the doctor is necessary in the case of a diffuse feeling of illness, a general feeling of malaise, a decrease in the usual level of performance, and an increased need for sleep. An inner restlessness, unexplained anxiety, greater weight loss, apathy, and increased irritability indicate irregularities that should be reported to a physician. The permanent feeling of lack of strength or energy, changes in mucous membranes or skin appearance, and a sensation of pain, are indications of an existing disease. If sensory disturbances, restrictions in mobility or psychological abnormalities develop, a doctor should be consulted. If there is a deviation from the usual behavior, a visit to the doctor is recommended.
Treatment and therapy
Therapy includes exactly three different strategies: surgical removal, chemotherapy, and radiation of the tumor. All three are very radical procedures that can cause a lot of collateral damage, but in the best case, they remove the tumor from the body along with its last cancer cell, thus defeating the disease once and for all. Due to their superficial location, many carcinomas are initially easy to operate on, especially when they are still in a fairly small stage. Depending on the stage, however, this is often followed by chemotherapy or radiation in order to also clear the surrounding tissue (lymphatic drainage channels) and the entire body (metastases) of scattered tumor cells. However, these treatment methods must be used with caution, as they are poison for the entire body and can have a lot of side effects. On the other hand, according to current research, they are usually the only way to comprehensively and safely treat a cancerous tumor. More targeted drugs are currently under development and are already available only in isolated cases (e.g., for certain types of leukemia).
Outlook and prognosis
Thanks to medical and scientific advances, the prognosis for carcinoma has improved significantly in recent years. Early detection measures, as well as public awareness, are enabling diagnosis and early treatment in many patients at the early stages of the disease. This approach improves the prognosis and the prospect of a lasting recovery. Nevertheless, there is no universal prognosis when it comes to carcinoma. It always has to be examined individually, where in the organism the formation of the tumor has occurred and at what speed the growth is taking place. Some areas in the body are difficult to access and other regions allow early detection only in rare cases. The further the tumor has grown in the organism, the older a patient is and the more previous diseases he has, the less favorable the prognosis becomes. Lifestyle, general health and psychological stability also have an influence on the further healing process. Without seeking medical care, the patient is at risk of premature death. An aggressive or malignant tumor has no chance of spontaneous healing. It can only be treated and removed in a cancer therapy. It is a long-term therapy that is associated with various risks and has a risk of recurrence.
Prevention
Prevention is the best way to get through life cancer-free: Since the most common cancers in particular are clearly associated with risk behaviors, it’s probably safe to say so. This means in detail: Not smoking, little alcohol, avoiding nitrosamines, enjoying sunlight only in moderation, aiming for a high-fiber diet, and everything else that is considered good and healthy. There are specific preventive measures against individual cancer entities, such as the HPV vaccination against cervical cancer. Furthermore, early detection examinations such as colonoscopy from 55 or mammography are highly recommended.
Follow-up care
Follow-up care represents a key element in the treatment of carcinoma. In this way, the recurrence of disease should be detected as early as possible, from which physicians hope to gain advantages in the course of therapy.After surgery, radiation or ablation, there is always a continuing risk of tumor recurrence. In addition, aftercare is also about providing everyday support. Patients often complain of psychological problems after surgery and need help with everyday life. It is not always possible to remove a carcinoma completely. In such cases, permanent treatment is often necessary. Daily drug treatment remains unavoidable. Patients usually attend a follow-up examination once every quarter or every six months. The frequency depends on the type of carcinoma, the symptoms and the stage of the tumor at the time of initial diagnosis. In most cases, the intervals between appointments are extended if no new growth has been detected after two to three years. The primary care physician or a clinic is responsible for follow-up care. Essential elements of an appointment are an intensive conversation and a physical check-up. An ultrasound examination and other imaging procedures are arranged on a regular basis. Blood tests to determine specific markers also take place.
What you can do yourself
The treatment of carcinoma is in the hands of experienced physicians, but the patient can do much to contribute to his or her recovery by adopting a positive attitude toward life. Above all, this includes coming to terms with one’s situation and accepting the disease: Open discussions with relatives, friends and other people affected can be extremely helpful. The organization of everyday life should be tailored to the current state of health and allow enough time for recreational breaks – this also includes accepting outside help in worse phases. Light sporting activities usually have a positive effect on the psyche and body; the intensity and extent should be discussed with the doctor treating the patient. Equally important is a healthy, balanced diet that protects against deficiencies and counteracts disease-related weight loss as best as possible. Several small portions a day are usually better tolerated than a few large ones. Sufficient fluid intake should also not be forgotten. Special relaxation exercises and acupressure can help to alleviate nausea caused by chemotherapy. Mistletoe preparations also have a reputation for alleviating side effects, but their effectiveness is controversial. If the carcinoma causes severe pain, it is useful to keep a pain diary. This should be presented to the physician at each visit so that he or she can quickly adjust drug therapy if changes occur.
